Drug therapy review in nursing homes: proposed standards and guidelines

In 1974, the Department of Health, Education, and Welfare mandated monthly drug regimen reviews by pharmacists for all Medicaid-financed residents in skilled nursing facilities. In 1980, proposed federal regulations were developed to extend the benefit of that type of review to residents of intermediate care facilities. The Government Accounting Office, in the meantime, found that a definition of the scope of medication review is still lacking, as is a single source of information on drug monitoring. As the proposed regulations and the corresponding guidelines appear to have severe shortcomings, the authors developed new standards and guidelines for the Baltimore City PSRO. Foremost in these is the statement that drug regimen review is not complete until the physician has responded in writing in the patient's chart to any recommendation the pharmacist-consultant has made.     

Influence of military sexual assault and other military stressors on substance use disorder and PTS symptomology in female military veterans

Servicewomen exposed to traumatic stressors over the course of their military service are at increased risk of developing symptoms of substance use disorder (SUD) and posttraumatic stress (PTS). They are also at risk for exposure to military sexual assault (MSA), which is also associated with SUD and PTS symptomology. Research is unclear about the incremental contributions of different forms of traumatic stressors on co-occurring SUD and PTS symptomology. In this study we examined the independent and combined effects of MSA and other military stressors on SUD and PTS symptomology in a sample of female veterans (N = 407). Results indicate that MSA and other military stressors exhibit incremental effects on SUD and PTS symptomology. Results further suggest that women exposed to both MSA and other military stressors are at increased risk for developing co-occurring SUD and PTSD. These findings extend previous research on comorbid SUD and PTSD, highlighting the cumulative effects of traumatic stressors on posttraumatic psychopathology, and have implications for future research and clinical practice with female veterans.     

实施药品集中招标采购的问题探讨

为了进一步推动医疗卫生体制改革的步伐，规范医药产品的购销行为，整改药品流通秩序，减轻患和社会的医疗负担，广州市于2002年起在省属、市属及部队所属医疗机构分批开展了药品集中招标采购工作。广州市天河区中医医院从2003年开始参加药品集中招标采购工作。通过3年实践，药品集中招标采购工作得以规范、平稳、有效地进行，取得了良好的效果；同时也发现了一些问题，如药价仍然虚高、医院采购成本及工作量增加、药品生产及经营企业负担加重，这些问题的出现不利于药品集中招标采购工作继续深入地开展下去。     

Semen analysis of military personnel associated with military duty assignments

A collaborative study between the U.S. Army Biomedical Research and Development Laboratory (USABRDL) and the National Institute for Occupational Safety and Health (NIOSH) was designed to assess fecundity of male artillery soldiers with potential exposures to airborne lead aerosols. Potential exposure assessment was based upon information provided in an interactive questionnaire. It became apparent from extensive questionnaire data that many soldiers in the initial control population had potentially experienced microwave exposure as radar equipment operators. As a result, a third group of soldiers without potential for lead or microwave exposures, but with similar environmental conditions, was selected as a comparison population. Blood hormone levels and semen analyses were conducted on artillerymen (n = 30), radar equipment operators (n = 20), and the comparison group (n = 31). Analysis of the questionnaire information revealed that concern about fertility problems motivated participation of some soldiers with potential artillery or microwave exposures. Although small study population size and the confounding variable of perceived infertility limit the reliability of the study, several statistically significant findings were identified. Artillerymen who perceived a possible fertility concern demonstrated lower sperm counts/ejaculate (P = 0.067) and lower sperm/mL (P = 0.014) than the comparison group. The group of men with potential microwave exposures demonstrated lower sperm counts/mL (P = 0.009) and sperm/ejaculate (P = 0.027) than the comparison group. Variables used to assess endocrine, accessory sex gland, and sperm cell function were not different than the comparison group. Additional studies, incorporating larger numbers of individuals, should be performed in order to more optimally characterize potential lead and microwave exposure effects on male fecundity.     

对药品采购实施两票制的分析与思考

长期以来,“医药合业、以药补医”的体制虽然在特定历史阶段促进了我国医药卫生事业的快速发展,但也为“看病难、看病贵”的顽疾埋下了体制性成因。深化医药卫生体制改革选择以改革公立医院药品采购方式、整肃和重建医药生产流通秩序作为切入点和突破口,对药品实行分类采购,属于挂网集中采购的药品在医改省市实施“两票制”,压缩过多和相对无序的商业流通环节。作为降低药品流通成本、破除药价虚高的有益探索尝试,从源头上治理长期困扰医药卫生行业的药价虚高、商业贿赂屡禁不止等问题,以促进医药流通兼并整合。     

武汉市胰岛素带量采购情况分析

目的:为其他省份乃至国家生物制品的药品带量采购工作启到借鉴的作用.方法:从武汉市胰岛素基本情况分析、胰岛素带量采购议价细则、胰岛素谈判议价结果3个方面对武汉市胰岛素带量采购情况做了一个整体分析.结果:武汉市制定了《带量采购中选药品采购量分配办法》,明确了保持医院用药习惯、减少品种更替原则,签订854份合同,签订合同量为...     

三明市药品限价采购政策效果研究（英文）

研究三明市药品限价采购政策的效果。通过对比福建省七八标和三明市第一次药品限价采购数据和实地调研,分析限价采购在品种、价格、供应、企业结构等方面的变化。结果发现:(1)限价采购后,采购品种和企业数量减少,品种和企业结构得到优化。(2)采购药品总体可以满足临床用药需求,但小部分药品存在断货现象。(3)药品价格总体下降,单价5元以上国产药品降幅约10%,进口药品降价少,单价低于3元的低价国产药品有一定涨幅。三明市药品限价采购政策在优化采购结构、控制"药价虚高"、完善产业结构等方面有明显成效,但也存在部分药品供应不足、进口原研药难降价等问题。     

Duloxetine in military posttraumatic stress disorder

The objective of this prospective study was to assess the efficacy and tolerability of duloxetine in the treatment of in military veterans with posttraumatic stress disorder (PTSD).Twenty subjects were enrolled in this 12-week, open-label trial. Diagnosis and symptom severity were assessed with the Clinician Administered PTSD Scale (CAPS). Depressive symptoms were assessed the Hamilton Depression Rating Scale. All subjects had a CAPS score of at least 60 at baseline. Subjects with lifetime history of psychotic disorders or bipolar illness were excluded. Fifteen participants completed 12 weeks of treatment, five dropped-out from the trial, 3 due to side effects. For patients who discontinued, missing values were estimated using "the last observation carried forward" method. Significant improvements were seen on: CAPS total and all subscales, depression and sleep measures. Most of the improvement was observed by week 2 of treatment. Nine participants (45%) were classified as responders, defined by 20% or greater improvement on CAPS total score. The mean daily dose of duloxetine was 81 mg. The most common side effects were constipation (20%) diarrhea (25%) and nausea (20%). Two subjects developed tachycardia, one withdrew from the trial due to this problem. Duloxetine had a fast onset of action and was effective in about half of the subjects, it was well tolerated in most subjects. These preliminary results in a difficult to treat population warrant the conduction of a double blind, placebo-controlled study of duloxetine in PTSD.     

Integration of formulary systems with centralized pharmaceutical procurement

The integration of formularies with pharmaceutical group purchasing and supply systems for multiple hospitals and ambulatory health centers in the Indian Health Service of the US Public Health Service is described. Two models by which these systems have been integrated are presented. The approach of one group of facilities for maintaining high-quality therapeutics in a cost-effective manner was to maintain separate P & T Committees and formularies for each facility, with one centralized drug procurement center. The other group developed a central P & T Committee and formulary to serve all area facilities, as well as continued to maintain a separate P & T Committee at each facility that could act between meetings of the central committee. These models of centralized procurement have provided both decreased drug costs and increased information on drug use within the multifacility systems. In both models, staff have reached consensus on drugs that will provide quality therapeutics in a cost-conscious environment.     

军队合理医疗用药政策调整前后军人住院药品保障水平对比研究

目的 评估部队医院2009年和2011年军人住院患者药品保障水平是否存在显著性差异并分析原因,为今后合理医疗政策的调整提供借鉴。方法 选取全军16家部队医院急性单纯性阑尾炎、冠状动脉粥样硬化性心脏病、慢性支气管炎和2型糖尿病4种疾病军人患者的药物治疗数据,运用统计学相关方法对2009年和2011年的药品保障水平相关指标进行对比研究。结果 16家医院的3748份病例显示,军人住院药品保障水平2009年和2011年在药品总费用、药品品种数、住院日均药费、主要治疗药物费用等较多指标上存在显著性差异,2011年高于2009年。结论 本次课题全面直观地展示了军人患者在2009年和2011年中4种军队常见多发病的用药详情,反映了2011年和2009年相比,某些疾病的用药水平显著提高;建议今后建立一种长期、固化的政策监管与评价手段,科学评价研究,为今后的药物政策调整提供有力证据。